Pregnancy & Birth
Recommended Books and Films About Childbearing
The pregnant woman's interests may indeed conflict with those of both obstetrician and hospital: If she wants to be in control of the circumstances surrounding the birth of her baby, it would be reasonable for her to decide to look elsewhere if possible. Yet instead of encouraging that awareness, S&S tells her that she has to somehow "be aware of the inevitably diverse interests that are involved in obstetrics and make arrangements that realistically take these into account. A simple fact of life is that you can count on people to serve your best interests if they see these as also being in their own interests, or at least not in conflict." (S&S 84) She learns only one way to avoid these conflicts: She should shop around for the doctor who should "protect you from aggressive residents, anesthesiologists and nurses. He himself should avoid unnecessary prophylaxis, minimize environmental disturbances, and resist the ever-present temptation to tamper" (AGB 99) He should explain why intervention is necessary and list the side effects. And he should have "patience, humility, caring, tolerance, sensitivity and humor, qualities that are not particularly cultivated in medical training." The second half of this sentence negates the first half). The assumption is also made that if these qualities are present in the initial interview they will persist during labor and delivery.
In the same vein the author continues: "Doctors who are partners, not bosses, have less pressure on them to be godlike. All of us can, and do, make mistakes -- including physicians. Inviting a doctor to be your partner ultimately allows him to function at his best" (AGB 103). (There are doctors who consider each woman's pregnancy as an individual and special event, who value good communication and respect their clients. Such an attitude requires recognition of the other's strengths. It involves balancing women's beliefs, self-knowledge and wishes with a doctor's experience. But the authors have emphasized that obstetricians acquire a set of priorities, beliefs and mechanisms for survival during training and practice which can all too quickly come into conflict with a woman's desire to take (or share) responsibility. Rarely does each party have equal access to power. Though doctors may bend here or there, it becomes almost second nature for them to insist on control. The statement "You hire him as a source of specialized information and as a technician with pertinent skills" (AGB? 105) may be more in line with what obstetricians actually learn, but is this the appropriate practitioner for pregnancy, labor and birth, or simply for backup help if emergencies arise?).
After reading that midwifery skills and attitudes are preferable, women are told to seek out surgical specialists who have neither the inclination nor opportunity to learn these skills. A complete lack of explanation for this hiatus should give rise to questions: Are the authors unaware of what they are saying? Do they know enough about midwifery to make meaningful distinctions between midwifery and obstetrics? Do they really believe that most women, given alternatives, will choose obstetricians? Or do their discussions originate in some fundamental awareness that most women, in fact, have very little real choice? Are women free to make choices when power relationships are so unequal and the medical view of birth is so institutionalized? "Unfortunately... the smorgasbord in obstetrics is largely illusory because one or two choices can determine the rest of the menu." (S&S, 7). As a mere reader one might tolerate this dissonance but as a pregnant woman seeking guidance for one of the most important events of her life...what is she to think?
Only those women who live in an area populated with many kinds of practitioners, who are not bound by the regulations of their HMO or their insurance policies, and who have enough time and money to look around can dream of choice. Even then they can be locked into medicalized care while being encouraged to fight its philosophy and practice. Urged to develop offensive or defensive strategies (or a combination of both) they find themselves in the untenable position of having to depend on the people they are strategizing against. Too often the struggle takes place in the midst of labor. It is no wonder that a woman wanting a normal birth feels she has to "prove" herself, to produce a "perfect" experience out of the choice which she and only she has made. No wonder she feels tense, beleaguered, assaulted, then gives up her autonomy bit by bit. No wonder that she blames herself when she "fails." Though she may have learned a lot, she has not been given the analytical tools for understanding that she and her doctors are acting out a drama set into motion and perpetuated by forces beyond themselves.
I suggest that these two books are organized and worded in ways that prejudice and direct the reader's thinking. Although certain comments may seem to conflict with some of the information offered, they indicate that the authors' own ideologies were shaped more by medical indoctrination than by any convincing, lived experience of alternatives. It is like advising a fledgling diver not to experience the sweep and feel of the dive but to begin by being terrified of breaking her neck. In reality there is no such thing as a "balanced" point of view -- the medical outlook is weighted far more heavily than its "opposite." The underlying imbalance betrays women by holding out the desireability and possibility of choice, and then subverting the most valuable insights and recommendations.
Your Baby, Your Way
Your Baby, Your Way (YBYW) Sheila Kitzinger (1987), extremely knowledgeable about birth, has talked with hundreds of women. Her five children were born at home. She has studied birth in many countries, lectured round the world and written many useful books. She understands women's wishes and needs as well as anyone. Her personal warmth shines through the text: "When you really start to swim with the waves of contractions, it can be a deeply satisfying experience. I remember feeling myself -- and I am a far from athletic person -- 'Oh, this is a sport I can really do!'" (244)
While words and philosophy are weighted one way, the organization of the book tells a different story, and organized in rigid obstetrical categories.. For instance, the unit entitled "The Way Birth Is" is divided into six parts. "The Journey Through Labor" consists of a schematic table detailing the phases of labor, the physical signs, how a woman might feel, how she can help herself and what her companion can do. In providing these guidelines, the author describes a "typical" abstract labor. Such guidelines can be comforting and helpful, but description can become prescription if women feel their labors are not "normal" when they arenít following the sequence and timing of events outlined in the book.
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